By Andrew Nusca
Posting in Design
Hospitals are getting smarter, faster, and more efficient. But can technology get out of a doctor's way when caring for a patient? Siemens Healthcare's Luis Castillo weighs in.
They're getting faster, cheaper and more energy-efficient.
And with electronic medical records, doctors and nurses are boosting the accuracy of their work and ensuring that patient care remains in line with the most important of medical promises: "Do no harm."
According to Siemens Healthcare senior vice president Luis Castillo, technology can help keep patients safe in the healthcare system -- but it can't do the job alone.
Siemens Healthcare is no stranger to the industry, of course -- it provides technology for medical imaging, therapy, laboratory diagnostics and IT solutions, from prevention to therapy. In fact, the company recently announced a contract with United Health Services in Binghamton, NY to deploy Soarian, the company's web-based healthcare information system.
I spoke to Castillo about how the best health tech fades into the background and allows a physician or nurse to do their jobs.
SmartPlanet: What is the state of healthcare in 2010? And what part does Siemens play?
LC: Our key goal is to improve a patient's care, one life at a time. Investing in healthcare IT, diagnostic systems and imaging systems, that really surrounds the patient with three pillars. The IT part we think is the backbone that ties these things together. The future of healthcare has to have a very efficient integrated platform, or you're not going to get anything out of it.
Some of it depends on what the provider is currently using. We have over 500 hospitals in the United States, and some of them haven't implemented an electronic [patient] record. Others are well on their way. Holistically, it's changing a lot.
High-tech is driving the change to all these areas. I don't think [healthcare providers] are going to be immune -- not if you want to stay in business.
SmartPlanet: What are some of the problems that technology can solve?
LC: This is about patient safety. In 2000, there was an article that came out called "To Err is Human" that described 200,000 deaths from medical errors each year in the United States. An enormous amount.
If we were in the airline industry, you would never get on the plane.
But because these errors are happening in isolated areas of the country, one at a time, it doesn't have the shock and awe of crash-and-burn plane wreckage on CNN.
It's about raising the bar.
This isn't rocket science stuff, it's just a matter of applying technology to it. Healthcare affects patient lives. You've got to get it right. It's got to be bulletproof, or else it's going to hurt people.
Take barcoding. Barcoding's been around for awhile, and now we use it to scan the patient, the room, the right dose, the right time and the right route. You get five rights, the [laser] gun gives you a green light that says you're good to go. You don't, you get a red light, and you may have a duplicate order, or the wrong dose. These are the errors that technology can help prevent.
Or standardization; getting everyone to agree to use the same standard. Some of this took legislation, some of it took time, some of it took getting hand-held devices small enough for nurses to use.
And rigorous testing. We're not NASA, but we want to ensure that when we do deploy it, it will help, rather than hurt.
Or medication administration checking: sometimes we argue, is it faster? Is it better? I look at it sometimes like Guitar Hero or whatever. I start out pretty bad, but I get better at it. A lot of our IT systems are like that -- they do make you change your processes or flow, but after that, it's second nature.
The five rights of medical administration are:
- Right patient
- Right time and frequency of administration
- Right dose
- Right route of administration
- Right drug
One nurse told me, "I go home every night feeling better that somebody is checking on me."
SmartPlanet: What technologies are making the most impact?
LC: Electronic patient records. There are a couple of phrases you don't hear in an electronic hospital anymore. You don't hear, "where's the chart?" -- it can be accessed with an iPad or iPhone from home or on-site.
You don't hear "exploratory surgery" anymore. With the tests and diagnostics available now, the idea to go in and explore is just out of the question.
Computerized chart and computerized physician order entry. The system navigates and intelligently tells you drugs that could interact [with a prescribed drug].
Electronic charts. Storage systems that carry terabytes of data are replacing those countless banks of shelves. In a digital hospital, what you're seeing ... electronic data interchange. All that [personal] information doesn't have to be asked anymore. You avoid language barriers. You're minimizing error points.
Systems are becoming advisers to physicians. I never want to take away the decision-making capabilities of physicians. But you do want to aggregate data. The ability to access this data online in real-time is really helping physicians carve their treatment in a personalized way.
You hear about doctors working 18, 20 hour shifts asking, "Did I put in that order?" These are the things that an IT platform can help you with. It's not there to hamper efficiency or take away time. It's there to guide you so that you're allowed to do the most important thing you're supposed to do: patient care.
SmartPlanet: How do you measure success at a given location?
LC: We do have an outcomes-based approach. We work with customers to benchmark them before the IT system goes in place and after the IT system goes in place.
Soarian has an embedded work flow engine into it. It allows you to monitor certain healthcare or medical processes in the organization.
If you put in a physician order entry system, and a certain amount of time passes, the system keeps looking: did that ever get signed off? Will it be late? If so, it sends it to the attending [physician] and keeps things moving. It's a web-native platform.
The best thing we can do is have customer testimonials. Really educating caregivers on this. There is a whole new generation of physicians coming that are very computer-savvy and do not get intimidated by technology.
But there are physicians out there that do not know how to use a mouse.
There are a lot of standards that we do on a smart user interface. Giving you a cockpit that is what I call "self-evident." We use a lot of industrial engineering in our process. We really look at how many mouse clicks -- you have to be three clicks away.
You can't design a system for a [single] person. If you have to use a manual...I'm not trying to replace a doctor. It's just smart design.
SmartPlanet: The healthcare industry is driven by routine. How do you get providers to upgrade?
LC: There is a lot of change rocking the healthcare industry right now. Meaningful use and new regulations are driving it -- nobody can argue with that.
The thing we need to take account for is, how much can be absorbed at once? We really have to be careful that we don't overload the system with [clinical] requirements. It's just a lot for a healthcare provider organization to absorb in a very short period of time.
It really depends on what's currently being used by the provider. We go through a very sophisticated roadmapping process that says, here's where you are today, here's where the criteria say you need to be in phase one, two and three. There is a thought-leadership or consultative approach to this that we at Siemens pride ourselves on.
Aug 4, 2010
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Folks, I was a critical care specialist for 43 years. From the day we first started using balloon pumps and holding patients in recovery rooms because they had the most attentive nurses. What we need are very smart, very attentive and dedicated health care providers. At one time smart women had a choice between nurse and teacher. Now those people are doctors and professors. That is a problem. Nurses are the first line of defense and protection for all the problems of health care. The doctors spend a little time in the hospital or with the patient in his office but if you have a heart attack and need resuscitating at 3 am it is the nurses who are going to bail you out. They need to be top notch and nothing less. I see two levels of RN's developing and it is going to cause massive problems if the people who are educating them do not figure out how to heal the rift. Perhaps the 2 year grad can begin his or her practice in the outpatient clinics while heading back for the other two years of schooling. I don't know how they will solve it but the responsibilities of critical care, and all patient care is critical, requires more than a two year degree.
In addition to technology providing useful clinical information during the care encounter, timely patient educational solutions and real time tracking applications are other technologies that "stay out of the way during clinician care". The simple checklist concept, as Dr. Gawande showed in his book "The Checklist Manifesto - How to Get Things Right", should be integrated into any technologies being deployed.
Luis ceems to be on track with applying technology to healthcare. The more checks and balances built into the healthcare system th better the outcome for the patient, hospital and doctors. This is so important because the heathcare providers are loaded with enough patients they can not spend the time to research each thing the have to do to avoid mistakes. Keep up this important work Luis.
...and read the article of too high radiation caused by the Siemens x-ray machines in stroke patients. NYTimes had an article about that. Of Siemens denied all charges. Healthcare will only get better when individuals and companies take the responsibility, and we drop the tendency to sue so quickly. Errors will be made, but one has to live up to what one does. Death is inevitable.
What about secondary infection control? Secondary infections currently cost the health system BILLIONS of dollars and cost thousands of lives every year!